RASMUSSEN UNIVERSITY
NUR 2063: Essentials of Pathophysiology Exam 1
Official Practice Exam | 2026/2027 Edition
Verified Questions and Answers | A+ Graded | Latest 2026/2027 Edition
Questions: 75 | Minutes: 90 | Passing Score: 80% | Sections: 5
Table of Contents
Section 1: Cellular Biology & Cellular Adaptation (15 questions, starting at Q1)
Section 2: Innate Immunity & Inflammation (15 questions, starting at Q16)
Section 3: Adaptive Immunity (15 questions, starting at Q31)
Section 4: Neoplasia & Cancer Biology (15 questions, starting at Q46)
Section 5: Fluid, Electrolyte & Acid-Base Imbalances (15 questions, starting at Q61)
Instructions
This practice exam contains 75 multiple-choice questions divided into 5 sections. You have 90 minutes to
complete the exam. Select the single best answer for each question. A passing score of 80% (60 out of 75
correct) is required. Each question has four answer choices (A, B, C, D). The correct answer and rationale are
provided immediately after each question for study purposes. An answer key is provided at the end of the exam.
NUR 2063 Pathophysiology -- 2026/2027 | Passing Score: 80% | Page 1 of 40
, Section 1: Cellular Biology & Cellular Adaptation
Q1 Question 1 of 75
A 68-year-old male with a 40-pack-year smoking history presents with chronic cough and dyspnea.
Pulmonary function tests reveal reduced FEV1 and a chest CT shows flattened diaphragms. The
nurse recognizes that the alveolar wall destruction seen in emphysema is most directly caused by
which cellular mechanism?
A. Release of lysosomal enzymes during necrosis leading to digestion of alveolar septa
B. Irreversible mitochondrial swelling triggering oncosis in type I pneumocytes
C. Protease-antiprotease imbalance with unchecked elastase activity destroying elastic fibers
D. Free radical-mediated lipid peroxidation of alveolar capillary basement membranes
Correct Answer: C
Rationale:
Emphysema results primarily from an imbalance between proteases (especially neutrophil elastase) and antiproteases
(such as alpha-1 antitrypsin). When elastase activity is unopposed, it destroys the elastic fibers in alveolar walls,
causing permanent enlargement of air spaces. While free radicals contribute to lung injury, the hallmark mechanism is
protease-driven tissue destruction, not lipid peroxidation of basement membranes.
Q2 Question 2 of 75
A 55-year-old female undergoes a thyroidectomy for multinodular goiter. On postoperative day 3,
pathology confirms that the enlarged thyroid was due to an increase in the number of follicular cells
rather than an increase in cell size. This cellular adaptation is best classified as which of the
following?
A. Hypertrophy, because the gland increased in overall mass and volume
B. Dysplasia, because the cells show disordered growth and atypia
C. Metaplasia, because one mature cell type was replaced by another
D. Hyperplasia, because the increase in gland size resulted from cell proliferation
Correct Answer: D
Rationale:
Hyperplasia is defined as an increase in the number of cells in a tissue, leading to organ enlargement. In the thyroid,
TSH stimulation causes follicular epithelial cells to proliferate, producing a goiter. Hypertrophy refers to an increase in
individual cell size, not cell number, which is not the primary mechanism in multinodular goiter.
NUR 2063 Pathophysiology -- 2026/2027 | Passing Score: 80% | Page 2 of 40
, Q3 Question 3 of 75
A 42-year-old construction worker sustained a traumatic amputation of his left lower extremity. Six
months later, he reports significant shrinkage of the residual limb muscles. The pathophysiologic
process responsible for this change is best described as which type of cellular adaptation?
A. Atrophy due to decreased workload and loss of trophic stimulation
B. Metaplasia due to chronic mechanical irritation at the amputation site
C. Hypertrophy due to compensatory overuse of the remaining limb muscles
D. Dysplasia due to disordered cellular maturation in denervated tissue
Correct Answer: A
Rationale:
Disuse atrophy occurs when cells decrease in size due to reduced functional demand or loss of innervation. After
amputation, the residual limb muscles experience significantly decreased workload, leading to shrinkage of individual
muscle fibers. Metaplasia involves replacement of one cell type with another, not a reduction in cell size.
Q4 Question 4 of 75
A 72-year-old male with a long-standing history of gastroesophageal reflux disease (GERD)
undergoes upper endoscopy, which reveals salmon-colored mucosa in the distal esophagus. Biopsy
confirms intestinal-type columnar epithelium replacing the normal squamous epithelium. This finding
represents which cellular adaptation?
A. Hypertrophy of esophageal smooth muscle in response to chronic reflux
B. Dysplasia with malignant transformation of squamous epithelium
C. Hyperplasia of the basal cell layer of the esophageal squamous epithelium
D. Metaplasia as the squamous epithelium is replaced by columnar epithelium
Correct Answer: D
Rationale:
Barrett esophagus is a classic example of metaplasia, in which the normal squamous epithelium of the esophagus is
replaced by intestinal-type columnar epithelium in response to chronic acid exposure. This is a protective but potentially
precancerous adaptation. Dysplasia implies disordered growth with atypia, which may develop later but is not the initial
change described.
NUR 2063 Pathophysiology -- 2026/2027 | Passing Score: 80% | Page 3 of 40
, Q5 Question 5 of 75
A 48-year-old female presents with jaundice, fatigue, and elevated liver enzymes. Liver biopsy
reveals hepatocytes with clear, vacuolated cytoplasm that stains positive with Oil Red O. The nurse
understands that these findings indicate which type of cellular accumulation?
A. Glyogen accumulation due to impaired glucose metabolism in hepatocytes
B. Pigment accumulation from excessive bilirubin conjugation and excretion
C. Protein accumulation due to defective ubiquitin-proteasome degradation pathways
D. Lipid accumulation (steatosis) resulting from impaired fatty acid oxidation or increased
synthesis
Correct Answer: D
Rationale:
Hepatic steatosis (fatty liver) is characterized by accumulation of lipids within hepatocytes, appearing as clear vacuoles
on H&E and staining positive with Oil Red O on frozen sections. This occurs when fatty acid oxidation is impaired or
triglyceride synthesis exceeds the capacity for export as VLDL. Glycogen accumulation would stain with PAS, not Oil
Red O.
Q6 Question 6 of 75
A 60-year-old male suffers an acute myocardial infarction. Troponin levels are markedly elevated,
and ECG shows ST-segment elevation. Cardiomyocyte death in the infarct zone is primarily mediated
by which mechanism?
A. Apoptosis triggered by p53 activation in response to DNA damage from ischemia
B. Autophagic cell death due to lysosomal degradation of essential organelles
C. Necrosis resulting from irreversible mitochondrial injury and ATP depletion
D. Pyroptosis mediated by caspase-1 activation in response to inflammatory signals
Correct Answer: C
Rationale:
In acute myocardial infarction, severe ischemia causes irreversible cell injury through oxygen deprivation, leading to
ATP depletion, mitochondrial failure, and membrane rupture -- the hallmarks of necrosis. Unlike apoptosis, necrosis is
an unregulated, inflammatory form of cell death. Apoptosis requires ATP and produces neat cell fragments without
inflammation, which is not the primary mechanism in infarction.
NUR 2063 Pathophysiology -- 2026/2027 | Passing Score: 80% | Page 4 of 40
NUR 2063: Essentials of Pathophysiology Exam 1
Official Practice Exam | 2026/2027 Edition
Verified Questions and Answers | A+ Graded | Latest 2026/2027 Edition
Questions: 75 | Minutes: 90 | Passing Score: 80% | Sections: 5
Table of Contents
Section 1: Cellular Biology & Cellular Adaptation (15 questions, starting at Q1)
Section 2: Innate Immunity & Inflammation (15 questions, starting at Q16)
Section 3: Adaptive Immunity (15 questions, starting at Q31)
Section 4: Neoplasia & Cancer Biology (15 questions, starting at Q46)
Section 5: Fluid, Electrolyte & Acid-Base Imbalances (15 questions, starting at Q61)
Instructions
This practice exam contains 75 multiple-choice questions divided into 5 sections. You have 90 minutes to
complete the exam. Select the single best answer for each question. A passing score of 80% (60 out of 75
correct) is required. Each question has four answer choices (A, B, C, D). The correct answer and rationale are
provided immediately after each question for study purposes. An answer key is provided at the end of the exam.
NUR 2063 Pathophysiology -- 2026/2027 | Passing Score: 80% | Page 1 of 40
, Section 1: Cellular Biology & Cellular Adaptation
Q1 Question 1 of 75
A 68-year-old male with a 40-pack-year smoking history presents with chronic cough and dyspnea.
Pulmonary function tests reveal reduced FEV1 and a chest CT shows flattened diaphragms. The
nurse recognizes that the alveolar wall destruction seen in emphysema is most directly caused by
which cellular mechanism?
A. Release of lysosomal enzymes during necrosis leading to digestion of alveolar septa
B. Irreversible mitochondrial swelling triggering oncosis in type I pneumocytes
C. Protease-antiprotease imbalance with unchecked elastase activity destroying elastic fibers
D. Free radical-mediated lipid peroxidation of alveolar capillary basement membranes
Correct Answer: C
Rationale:
Emphysema results primarily from an imbalance between proteases (especially neutrophil elastase) and antiproteases
(such as alpha-1 antitrypsin). When elastase activity is unopposed, it destroys the elastic fibers in alveolar walls,
causing permanent enlargement of air spaces. While free radicals contribute to lung injury, the hallmark mechanism is
protease-driven tissue destruction, not lipid peroxidation of basement membranes.
Q2 Question 2 of 75
A 55-year-old female undergoes a thyroidectomy for multinodular goiter. On postoperative day 3,
pathology confirms that the enlarged thyroid was due to an increase in the number of follicular cells
rather than an increase in cell size. This cellular adaptation is best classified as which of the
following?
A. Hypertrophy, because the gland increased in overall mass and volume
B. Dysplasia, because the cells show disordered growth and atypia
C. Metaplasia, because one mature cell type was replaced by another
D. Hyperplasia, because the increase in gland size resulted from cell proliferation
Correct Answer: D
Rationale:
Hyperplasia is defined as an increase in the number of cells in a tissue, leading to organ enlargement. In the thyroid,
TSH stimulation causes follicular epithelial cells to proliferate, producing a goiter. Hypertrophy refers to an increase in
individual cell size, not cell number, which is not the primary mechanism in multinodular goiter.
NUR 2063 Pathophysiology -- 2026/2027 | Passing Score: 80% | Page 2 of 40
, Q3 Question 3 of 75
A 42-year-old construction worker sustained a traumatic amputation of his left lower extremity. Six
months later, he reports significant shrinkage of the residual limb muscles. The pathophysiologic
process responsible for this change is best described as which type of cellular adaptation?
A. Atrophy due to decreased workload and loss of trophic stimulation
B. Metaplasia due to chronic mechanical irritation at the amputation site
C. Hypertrophy due to compensatory overuse of the remaining limb muscles
D. Dysplasia due to disordered cellular maturation in denervated tissue
Correct Answer: A
Rationale:
Disuse atrophy occurs when cells decrease in size due to reduced functional demand or loss of innervation. After
amputation, the residual limb muscles experience significantly decreased workload, leading to shrinkage of individual
muscle fibers. Metaplasia involves replacement of one cell type with another, not a reduction in cell size.
Q4 Question 4 of 75
A 72-year-old male with a long-standing history of gastroesophageal reflux disease (GERD)
undergoes upper endoscopy, which reveals salmon-colored mucosa in the distal esophagus. Biopsy
confirms intestinal-type columnar epithelium replacing the normal squamous epithelium. This finding
represents which cellular adaptation?
A. Hypertrophy of esophageal smooth muscle in response to chronic reflux
B. Dysplasia with malignant transformation of squamous epithelium
C. Hyperplasia of the basal cell layer of the esophageal squamous epithelium
D. Metaplasia as the squamous epithelium is replaced by columnar epithelium
Correct Answer: D
Rationale:
Barrett esophagus is a classic example of metaplasia, in which the normal squamous epithelium of the esophagus is
replaced by intestinal-type columnar epithelium in response to chronic acid exposure. This is a protective but potentially
precancerous adaptation. Dysplasia implies disordered growth with atypia, which may develop later but is not the initial
change described.
NUR 2063 Pathophysiology -- 2026/2027 | Passing Score: 80% | Page 3 of 40
, Q5 Question 5 of 75
A 48-year-old female presents with jaundice, fatigue, and elevated liver enzymes. Liver biopsy
reveals hepatocytes with clear, vacuolated cytoplasm that stains positive with Oil Red O. The nurse
understands that these findings indicate which type of cellular accumulation?
A. Glyogen accumulation due to impaired glucose metabolism in hepatocytes
B. Pigment accumulation from excessive bilirubin conjugation and excretion
C. Protein accumulation due to defective ubiquitin-proteasome degradation pathways
D. Lipid accumulation (steatosis) resulting from impaired fatty acid oxidation or increased
synthesis
Correct Answer: D
Rationale:
Hepatic steatosis (fatty liver) is characterized by accumulation of lipids within hepatocytes, appearing as clear vacuoles
on H&E and staining positive with Oil Red O on frozen sections. This occurs when fatty acid oxidation is impaired or
triglyceride synthesis exceeds the capacity for export as VLDL. Glycogen accumulation would stain with PAS, not Oil
Red O.
Q6 Question 6 of 75
A 60-year-old male suffers an acute myocardial infarction. Troponin levels are markedly elevated,
and ECG shows ST-segment elevation. Cardiomyocyte death in the infarct zone is primarily mediated
by which mechanism?
A. Apoptosis triggered by p53 activation in response to DNA damage from ischemia
B. Autophagic cell death due to lysosomal degradation of essential organelles
C. Necrosis resulting from irreversible mitochondrial injury and ATP depletion
D. Pyroptosis mediated by caspase-1 activation in response to inflammatory signals
Correct Answer: C
Rationale:
In acute myocardial infarction, severe ischemia causes irreversible cell injury through oxygen deprivation, leading to
ATP depletion, mitochondrial failure, and membrane rupture -- the hallmarks of necrosis. Unlike apoptosis, necrosis is
an unregulated, inflammatory form of cell death. Apoptosis requires ATP and produces neat cell fragments without
inflammation, which is not the primary mechanism in infarction.
NUR 2063 Pathophysiology -- 2026/2027 | Passing Score: 80% | Page 4 of 40
